Intravenous Iron in Palliative Care Dr Wynitia Jones F2 Y Bwythyn Newydd, Bridgend

Content Introduction Methods Results Discussion Questions

Introduction Anaemia is common and multifactorial Blood transfusions are widely used A proportion of patients will present with iron deficiency anaemia Could iron infusions be a transfusion alternative?

Cost £147.50 for 1 unit £7.97 per 2mL amp (100mg)

Methods Literature search Case-note review of the last 20 patients who had blood transfusions establish how many had an iron-deficient picture Telephone survey across Wales how many are offering iron infusions Forums

Results: Case-note Review 20 notes reviewed 8 still alive 12 deceased Mean survival: 4.5 months Median survival: 4 months Range: 1 – 19 months IV Iron raises Hb by 1-2grams/week i.e. patients are surviving long enough to feel the benefits of IV iron

Breakdown of the FBC

Patients with Microcytic Anaemia Primaries: breast, colon, lung, prostate 3 = cancer related 1 = chemo related 2 did not require subsequent transfusions

Results: Telephone Survey 9 Inpatient units 3 oupatient units 2 community based units 11 units offered a blood transfusion service Very little use of IV iron across Wales

Results: Literature Search Improved side effect profile for low molecular weight iron dextran Lots of evidence for patients who are receiving erythropoeitic-stimulating agents having chemo I was unable to find evidence for our subset of patients

Results: Forums Dr Dean Blackburn “……the drive locally is very much to identify and treat all those with iron deficiency as a way of reducing overall blood requirements” ”Ferinject is a new one off treatment for Iron Deficiency (Not needing 6 or more doses like Venofer). No anaphylaxis potential, significantly more expensive but much cheaper than blood.” 

Diagnosis of Anaemia Identify iron deficient patients Microcytic indices are not diagnostic Normally comment on serum ferritin Consider looking at the total iron binding capacity

Evaluation Strengths Weaknesses Extensive literature search Limited number of patients assessed Established an impression of practice throughout Wales Telephone survey results difficult to interpret Used a range of sources New communications that need follow up

Discussion Very small population of patients Is this too small to change practice? Careful diagnosis is required Slower to raise Hb – may require a change in follow up

Potential to be cost effective Improved side effect profile Reduce the number of day hospital attendances Used elsewhere successfully

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